Radiologists Need SMART Strategies to Battle Stress

January 01, 2013

Therapy-based training programs, improved work environments and new technology are among the ways radiologists are combating stress and burnout.

Although radiologists pour a significant amount of energy into every aspect of their careers, few invest the time necessary to manage—or offset—the resulting stress and burnout that has been shown to hit radiology harder than some specialties.

Declining reimbursement, increased exam volume, growing isolation and the threat of malpractice greatly contribute to the specialty’s risk for stress and create a real need to develop a strategy to combat such stressors, according to nationally recognized experts. Along with therapy-based training programs, radiology departments are changing their work environment and embracing new technology offering easy-access to stress-reduction methods, among other strategies.

“Forty to 50 percent of physicians experience burnout nationally,” said Amit Sood, M.D., M.Sc., chair of the Mayo Mind Body Initiative and an associate professor of medicine at the Mayo Clinic in Rochester, Minn. That data was reflected in an October 2012 Archives of Internal Medicine study demonstrating that nearly half of radiologists reported at least one symptom of burnout. Only emergency medicine, general internal medicine, family medicine and neurology were at equal or greater risk of this problem, results showed.

Dr. Sood was the lead author on the RSNA 2012 presentation, “Stress Management and Resiliency Training (SMART) Program Among Department of Radiology Faculty: A Pilot Randomized Clinical Trial,” presented by co-author Brian Gorman, M.B.B.Ch., M.B.A., a consultant in the radiology department at the Mayo Clinic.

“Having observed some of the negative effects of stress in our radiology department, I asked Dr. Sood to lead this project for us,” Dr. Gorman said. “His program of training in attention and interpretation seemed well suited to the challenges facing radiologists.”

“We want to help radiologists understand that their situation is not unique and it’s not their fault,” said Dr. Sood, also director of research and practice for Mayo’s Complementary and Integrative Medicine Program. “Circumstances combined with the way our minds work makes stress unavoidable in the age we live in.”

In the study, 26 radiologists at the Mayo Clinic were randomized in a single-blind, wait-list controlled clinical trial to either the SMART intervention or a wait-list control group for 12 weeks. Radiologists participated in a 90-minute group session in the SMART program with two follow-up phone calls.

Researchers focused on building resiliency, or the ability to handle stress and bounce back. Because stress primarily results from the interaction between actual events and our perception of them, Dr. Sood works to retrain the mind—which often goes directly to the negative—to develop perceptions and responses that are positive and empowering.

For example, when most of us wake up, we immediately think about the tasks that lie ahead or the enormity of our workload. Instead, Dr. Sood suggests consciously beginning each day with a thought of gratitude—one exercise in what he calls “attention training.”

“Think of five people you are grateful for,” he says. “Picture each person individually and think about the blessings each offers you. Doing this every morning provides an immediate alternative to negative ruminations that often fill our head before we are even out of bed.”

Repeat this exercise multiple times during the day. “When you’re waiting for the computer to boot up or your mind is in wandering mode, learn to choose your sensory input,” he said. “The more you do it, the easier it will become.”

He also suggests taking a walk in nature each day if possible. “Look closely at the details of a tree trunk, the petals of a wild flower, listen closely to the sounds,” Dr. Sood said. “Just by being in nature you are engaging a part of the brain associated with joy.”

The Mayo Clinic study yielded promising results. Of the 22 physicians who completed the study, results showed a statistically significant improvement in perceived stress, anxiety, overall quality of life and mindfulness at 12 weeks in the study arm compared to the wait-list control arm.

And radiologists aren’t the only benefactors. “I believe addressing staff well-being is the best way to serve the needs of patients,” Dr. Gorman said.

Reducing Isolation Can Cut Stress

Because some stressors are a sign of the times—growing isolation due to technological advances, for example—one university is hoping to decrease stress and improve the work environment by taking a page from a simpler era.

At Brown University in Providence, R.I., John Cronan, M.D., spearheaded an effort to minimize isolation by joining two emergency room (ER) radiologists in one room instead of separating them—an arrangement common prior to the advent of PACs. Launched in October 2012, the initiative is extremely popular with radiologists who previously didn’t favor the ER rotation, primarily because of the isolation factor, Dr. Cronan said.

The university has also joined its ultrasound, body CT and body MR imaging into one large “body room” where four radiologists and four residents work together—also very popular, said Dr. Cronan, a professor of diagnostic imaging at Brown.

“In the old days, when radiologists were clustered together, you could take a break, ask someone a question or get a consensus on a case and you interacted with your colleagues,” Dr. Cronan said. “With PACs, there is no reason to have a central core reading site and the impact of the satellite arrangement is totally isolating.”

Isolation is compounded by what Dr. Cronan calls “volume creep,” in which declining reimbursement rates require radiologists to read more studies each day to maintain their current salary. “In a way you become a hamster on a treadmill,” he said. “You don’t realize that reading an extra 20 percent a year is taking a toll. As fast as your read them, more will pop up. And you’re in a room by yourself.”

Technology Offers Stress Relief

Although technology is something of a double-edged sword for radiologists, it is also forging new ground in easing stress.

Dr. Sood’s research was the basis for the Mayo Clinic startup, mRemedy, which launched the Mayo Clinic Meditation app for iPhone or iPod Touch and iPad in 2010. The app teaches users relaxation and breathing techniques and features Healing Thoughts, or gentle reminders that help users stay focused on the positive that can be shared via e-mail, text, Facebook or Twitter.

On another front, research in the October 2012 issue of the Journal of Digital Imaging explores the viability of voice stress analysis, which can be directly implemented through existing speech recognition technology and has been proven to be effective in stress measurement and analysis outside of medicine.

Despite such inroads, Dr. Sood said the demand for stress reduction methods continues to grow. “For every 10 patients referred to us, we are only able to see two,” he said.

Those not able to access his program directly have another option: Dr. Sood’s 2010 book, “Train Your Brain....Engage Your Heart....Transform Your Life: A Course in Attention & Interpretation Therapy (AIT),” available for purchase.

Whatever route radiologists take, Dr. Sood suggests choosing a strategy that helps reestablish that necessary connection to all parts of your world—beyond radiology. “It’s one thing to be blessed and another thing to remember you’ve been blessed,” Dr. Sood said.

Web Extras

Research by Amit Sood, M.D., M.Sc., was the basis for the Mayo Clinic Meditation app that teaches users relaxation and breathing techniques. The app, available for iPhone or iPod Touch and iPad, also features Healing Thoughts that help users stay focused on the positive. Image courtesy of the Mayo Clinic.